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Administrative Law Court
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SC Administrative Law Court Decisions

Betty J. Pitts vs. SCDHHS

South Carolina Department of Health and Human Services

Betty J. Pitts

South Carolina Department of Health and Human Services





This matter is before me pursuant to the appeal of Betty J. Pitts (Appellant), from a final decision of the Respondent, South Carolina Department of Health and Human Services (Department), denying the Appellant’s application for Medicaid benefits under the Aged, Blind or Disabled (ABD) program. The Administrative Law Court (ALC) has jurisdiction to hear this matter pursuant to S.C. Code Ann. § 1-23-600 (2005). On April 4, 2006, the Department filed a Motion to Dismiss this case. Appellant did not respond.


As set forth above, this case is before the Division as an appeal of an agency action pursuant to S.C. Code Ann. § 1‑23‑600(D) of the Administrative Procedures Act (APA) upon appeal from a Final Order of the Department. As such, the Administrative Law Judge sits in an appellate capacity under the APA rather than as an independent finder of fact. In South Carolina, the provisions of the APA -- specifically Section 1-23-380(A)(6) -- govern the circumstances in which an appellate body may review an agency decision. That section states:

The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions or decisions are:

(a) in violation of constitutional or statutory provisions;

(b) in excess of the statutory authority of the agency;

(c) made upon unlawful procedure;

(d) affected by other error of law;

(e) clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or

(f) arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

S.C. Code Ann. § 1-23-380(A)(6) (2005).


Factual/Procedural Background

Appellant applied for Medicaid benefits under the ABD program from on August 29, 2005. Upon referral to Respondent’s agent, South Carolina Department of Vocational Rehabilitation (VR), for disability determination, no evaluation was performed because the Social Security Administration (SSA) had made a disability determination within 12 months of the application date and denied Appellant’s application for disability. VR found that Appellant’s Medicaid application allegations were the same allegations made in his SSA application. The DHHS Hearing Officer found that pursuant to Federal law, 42 USC 435.541 (a) and (b), the Department was without authority to issue a decision inconsistent to the SSA determination.


Respondent argues in his Motion to Dismiss that when SSA has made a determination of no disability, the Department may not make an independent finding on that same issue since the SSA determination is binding. 421 CFR 435.541(b)(1) provides that Effect of SSA determinations an SSA disability determination is binding on a state agency until the determination is changed by SSA unless the applicant establishes an exception set forth in Section 435.541(c)(3). See also: Sebastian v. Commissioner of Human Services, 1993 WL 642701 (M.D.Tenn. 1993) (“Specifically, if the Social Security Administration (“SSA”) has made a determination of non-disability for SSI benefits purposes, then the state agency must defer to this decision and cannot re-determine Medicaid eligibility on disability grounds if SSA and the state have a section 1634 agreement. . . .”). In fact, under these federal regulations “the federal agency’s determination of nondisability supercedes [even] a previous state agency determination of disability.” Disabled Rights Union v. Kizer, 744 F. Supp 221, 224 (Cal. 1990).

Here, the evidence shows that SSA made a ruling on Appellant’s application within twelve months of Appellant’s Medicaid application and that the same allegations for disability were made in both applications. Appellant has not provided any reason at the hearing below or to this court why her prior SSA determination would not be binding pursuant to Regulation 435.541 (c)(3). Therefore, the Hearing Officer was without authority to issue an inconsistent ruling.

IT IS THEREFORE ORDERED that this appeal be dismissed.



Ralph King Anderson, III

Administrative Law Judge

May 8, 2006

Columbia, South Carolina

Brown Bldg.






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